Patients with acute kidney injury (AKI) may have increased long-term risks of cardiovascular (CV) mortality and other major CV events, particularly heart failure and heart attack, a new review suggests. 

Although a long-term risk of mortality is well established, it is less clear whether AKI promotes CV disease. So Ayodele Odutayo, MD, of the University of Oxford in the United Kingdom, and colleagues performed a systematic review and meta-analysis of 25 studies on AKI in any setting with at least 6 months of follow-up, published from 2003 to 2015. The studies involved 254,408 adults, including 55,150 with AKI. 

AKI was associated with an 86% increased risk of CV mortality, according to results published in the Journal of the American Society of Nephrology. In addition, it was linked with a 38% increased risk of major CV events, specifically a 58% increased risk of congestive heart failure (CHF) and a 40% elevated risk of acute myocardial infarction. CHF risk persisted in subgroup analyses based on AKI severity and pre-existing ischemic heart disease. AKI also was associated with a 15% increased risk of stroke, but the investigators suggested this finding may stem from residual confounding.

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“Taken together, the association between AKI, CHF, and acute myocardial infarction should receive greater attention from clinicians, particularly as small changes in clinical practice can improve outcomes for adults with AKI…” Dr Odutayo and colleagues stated. Reducing progression of AKI from mild to severe might reduce the risk of long-term CV problems. The findings also highlight the need for screening and management of CHF and acute myocardial infarction in AKI patients.

It remains possible that comorbidities rather than AKI itself increase CV risk, the investigators suggested. They also noted that definitions of AKI and AKI severity differed among the studies, limiting some analyses.

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1. Odutayo A, Wong CK, Farkouh M, et al. AKI and Long-Term Risk for Cardiovascular Events and Mortality. J Am Soc Nephrol.  2016 Jun 13. doi:10.1681/ASN.2016010105. [Epub ahead of print.]